Emergency department length of stay independently predicts excess inpatient length of stay

TLDR

To examine the association between emergency department length of stay (EDLOS) and inpatient length of stay (IPLOS). Retrospective review of presentations and admissions data from three metropolitan hospitals in Melbourne (1 July 2000–30 June 2001) measured mean IPLOS across four EDLOS categories, calculated excess IPLOS, and adjusted odds ratios for exceeding the state benchmark. Among 17 954 admissions, longer EDLOS correlated with longer IPLOS and higher excess IPLOS, with odds ratios for excess IPLOS rising from 0.68 (≤ 4 h) to 1.49 (> 12 h), showing EDLOS independently predicts exceeding the benchmark.

Abstract

Objective: To examine the association between emergency department length of stay (EDLOS) and inpatient length of stay (IPLOS). Design: Retrospective review of presentations and admissions data. Setting: Three metropolitan hospitals in Melbourne, 1 July 2000 to 30 June 2001. Main outcome measures: Mean IPLOS for four categories of EDLOS (≤ 4 hours, 4–8 hours, 8–12 hours, >12 hours); excess IPLOS, defined as IPLOS exceeding state average length of stay; odds ratios for excess IPLOS adjusted for age, sex and time of presentation. Results: 17 954 admissions were included. Mean IPLOS for the four categories of EDLOS were ≤ 4 hours, 3.73 days; 4–8 hours, 5.65 days; 8–12 hours, 6.60 days; > 12 hours, 7.20 days (P < 0.001). The corresponding excess IPLOS were 0.39, 1.30, 1.96 and 2.35 days (P < 0.001). Compared with EDLOS 4–8 hours, odds ratios (95% CIs) for excess IPLOS associated with the other three categories of EDLOS were ≤ 4 hour, 0.68 (0.63–0.74); 8–12 hours, 1.20 (1.10–1.30); and > 12 hours, 1.49 (1.36–1.63), after adjusting for elderly status, sex and time of ED presentation. Conclusion: EDLOS correlates strongly with IPLOS, and predicts whether IPLOS exceeds the state benchmark for the relevant diagnosis-related group, independently of elderly status, sex and time of presentation to ED. Strategies to reduce EDLOS (including countering access block) may significantly reduce healthcare expenditure and patient morbidity.